New Therapy Helps Paralyzed Man Walk
Spinal cord stimulation plus ambulatory therapy appear to work
TUESDAY, Feb. 5, 2002 (HealthDayNews) -- It was nothing short of a miracle for Ken Paulson of Phoenix, Ariz.
Paulson, 45, had been confined to a wheelchair since a car accident left him paralyzed from the armpits down four and a half years ago.
Today, because of a novel combination of two forms of therapy, Paulson can leave his wheelchair at home when he goes to the theater, the grocery store and restaurants.
"Any little bit of independence that we can get and we can hang onto, it's worth it," says Paulson, who was a carpenter until the accident. "There's always hope."
Paulson's "miracle" is partially due to partial weight-bearing therapy (PWBT), a tested technique where a patient is fitted into a harness while he or she "walks" on a treadmill. The harness takes about 40 percent of the body weight and the treadmill induces a walking rhythm. After working on the treadmill, Paulson could, with the assistance of a walker, progress about 50 feet.
The problem was that it took a long time, and the effort exhausted him.
"The biggest issue was fatigue," says Dr. Richard Herman, lead author of the study, which appears in the February issue of Spinal Cord. "We tried that for a while, then we decided that he would not be able to perform in a shopping mall or a restaurant or walking to and from a car effectively with such limitation in his effort reserve."
Herman decided to combine the ambulatory therapy with epidural spinal cord stimulation (ESCS), which has been used for pain control. Paulson had electrodes surgically implanted on top of his spine and a receiver implanted under the abdominal wall. A disk relays electrical instructions from a remote device about the size of a cell phone, which Paulson carries in his pocket or attaches to his belt.
The electrical current from the implanted electrodes appears to work by stimulating neurons. Paulson actually feels a tingling, though no pain, when this happens. In turn, that stimulates the circuits in the spinal cord that are responsible for walking. This causes the muscles to contract.
"It sends the stimulus directly to the nerves, exciting the spinal cord in that area. And this then enhances the ability to walk, and makes it less of an effort and makes it more efficient as far as the amount of oxygen utilized," says Dr. David Apple, medical director of the Shepherd Center, a spinal cord and brain injury rehabilitation center in Atlanta.
When Paulson walked on the treadmill with the ESCS, he was able to move faster with considerably less effort. Within a few weeks, he had cut the time it took to travel the same distance by a third. His effort, according to Herman, was now a 2 or 3 on a scale of 10, whereas before it had been a full 10. After four months, Paulson could walk 1,000 feet, and now he can get from his house to his car and from his car to the grocery store, where he rides an electronic scooter provided by the store.
"He took off," says Herman. "What we really facilitated was his effort stage."
"While this work is certainly preliminary, it sheds a light on new combination approaches to devastating spinal cord injuries," says Dr. Frank Schwab, associate director of spine surgery at Maimonides Medical Center in Brooklyn.
Herman, who is working with Arizona State University in Tempe, has permission to study three individuals who, like Paulson, have some movement -- though not functional movement -- in their lower extremities and are wheelchair-dependent.
The second study participant is now trying the combined therapy. Herman hopes that, eventually, the technique will help at least a quarter of the 250,000 Americans who have spinal cord injuries.
"We want the best of the wheelchair-dependent patients," says Herman. "If this is successful in maybe two out of three cases, we will then go and try this in a category that has more severe paralysis, patients who are totally paralyzed in the legs and have a little sensation."
What To Do
To learn more about a variety of spinal problems, visit Orthospine, the educational site developed by Schwab. The National Spinal Cord Injury Association and the American Spinal Injury Association also have a wealth of information.